Thoracic outlet syndrome. Proposed protocol for diagnosis and treatment

The clinical and aetiopathogenetic features of thoracic outlet syndrome are reviewed, and 51 cases treated by us over the last 10 years are analysed. A long-term follow-up (from 6 months to 10 years) was obtained in 24 patients, 19 of whom had been submitted to surgery. The long-term results were excellent or good in 15 patients and unchanged or worse in the remaining 9 cases. A careful retrospective survey of the history and clinical findings was carried out, including in particular the relevance of radiography of the cervical spine, EMG and Doppler tests. The type of surgery employed, which included both the supraclavicular and transaxillary approaches, was also taken into account. Based on this retrospective analysis the authors propose a protocol for diagnosis and treatment in a syndrome which is not always easy to interpret and which often crosses boundary lines in several specialist fields of medicine and surgery.